Oncology Services Specialist
 Carle Health | ||
 United States, Illinois, Urbana | ||
| 509 West University Avenue (Show on map) | ||
 Dec 27, 2024 | ||
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Overview
The Cancer Services Specialists is responsible for all the pre-authorizations and insurance inquiries within the cancer center. Understands payment denials and how to prevent denials to reduce losses; works and appropriately appeals the denials from insurance companies. The Cancer Services Specialist coordinates all cancer conferences/tumor boards at CCI-Urbana and CCI-Normal. They are responsible for ensuring all standards for CoC and NAPBC accreditations are met; tracking and entering data into the survey portal, coordinating and maintaining regular meetings of cancer committee and subcommittee and taking minutes. Cancer Services specialist play a key role in accreditation survey prep and reporting. Qualifications License/Certifications: Education: Other Knowledge/Skills: Healthcare Responsibilities Assumes primary responsibility in working with the third party payer for screening and authorizations for appropriate criteria/pre-certs/third party approvals Obtains, documents, verifies and conducts follow-up on insurance authorizations and insurance eligibility as required for scheduled exams Checks insurance eligibility to ensure that the information provided matches the insurance carrier's database information Prepares written communication to notify appropriate staff of authorization updates and/or changes for insurance carriers Interacts with external customers to inform and educate regarding authorization procedures Manages and resolves denied cases. In cooperation with Billing Department, works denials by sending appeal letters and making appropriate contact with insurance companies or billing staff Generates timely and compliant denial letters and to facilitate the submission of appropriate appeal documentation Provides recommendations for policy and procedure changes to management to prevent or limit denials Reviews and ensures diagnostic, ICD-10, and CPT code is utilized for ordering and pre-authorizations Schedules, prepares, and coordinates Administrative Cancer Committee Meetings, cancer conferences, and meetings. Assists with generating reports and gathering data for providers and staff in relation to accreditation activities. Maintains ongoing cancer conference case lists and distributes to attendees in a timely manner. Tracks cancer conference discussion to ensure all required elements are discussed for reporting to American College of Surgeons. About Us
Compensation and Benefits The compensation range for this position is $19.71per hour - $31.93per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate's experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits. | ||